Stabilization of Embolized Transcatheter Heart Valve With a Left Subclavian Artery Stent

BACKGROUND: Transcatheter heart valve (THV) embolization is a rare complication of transcatheter aortic valve replacement (TAVR) that can occur despite meticulous planning and execution. CASE SUMMARY: An 89-year-old man with paradoxical low-flow, low-gradient severe aortic stenosis underwent TAVR. During rapid pacing, a premature ventricular contraction occurred, and the valve embolized to the ascending aorta. A second THV was successfully deployed. The embolized THV was maneuvered into the distal aortic arch, at the ostium of the left subclavian artery (LSCA), and stabilized with an 8 × 39-mm VBX covered balloon expandable stent in the LSCA. DISCUSSION: Premature ventricular contraction-induced THV embolization is a rare complication of TAVR. We present a novel approach to managing THV embolization in TAVR. TAKE-HOME MESSAGE: If there is jeopardization of the LSCA due to the outer fabric of the THV valve frame, blood flow can be maintained by using a covered stent in the ostial LSCA.